University of Iowa News
Sept. 26, 2005
Photo: Michael Abramoff
UI Research Aims To Prevent Blindness In People With Diabetes
More than 18 million people in the United States have diabetes, yet more than half of them do not receive the annual retinal exam that helps prevent diabetic retinopathy, which can lead to blindness. In rural states like Iowa, people with diabetes are particularly at risk for not receiving regular eye exams.
However, University of Iowa researchers are developing approaches and adapting technology to make a retinal exam a routine, cost-effective part of a person's overall diabetes check-up.
The studies include researchers in the Department of Ophthalmology and Visual Sciences and the Department of Family Medicine in the UI Roy J. and Lucille A. Carver College of Medicine, the UI College of Engineering and the Veterans Affairs Iowa City Health Care System. Researchers in the state, region and overseas also are involved.
"Many people with diabetes go blind needlessly because their retinas never are examined on time," said Michael Abramoff, M.D., Ph.D., assistant professor of ophthalmology and electrical and computer engineering. "If you diagnose diabetic retinopathy early in a patient, you can treat it very well. But many people with diabetes do not have access to an ophthalmologist because of distance or other difficulties, and so, do not get an annual exam."
Currently, a routine eye exam involves having one's pupils dilated, and the analysis is done at the ophthalmologist's office. With travel time, a rural patient might spend up to half a day getting an exam. In many areas of Iowa, there is no ophthalmologist within 50 miles.
Abramoff, the principal investigator on the studies and an ophthalmologist with UI Hospitals and Clinics, said an additional problem exists. "Even if ophthalmologists did nothing but give annual eye exams to people with diabetes in the United States, there still would not be enough doctors to provide all the needed exams," he said.
To overcome these hurdles, Abramoff and collaborators are developing ways for family or internal medicine physician offices across the state to use digital cameras to take pictures of patients' retinas. The photos can be taken in 10 minutes, much more quickly than a typical eye exam.
Because diabetes damages small blood vessels in the eye, pictures can be analyzed for the small hemorrhages and signs of fluids that, if left untreated, lead to blindness. The photos are sent electronically to eye experts who determine if danger signs are present and inform the patient's doctor for appropriate follow-up care. The cameras already are being used on a small scale.
However, the digital camera needed currently costs $30,000 to $50,000, making it impossible for most family or other primary care physicians to have the device in their office. Abramoff has received a four-year, nearly $1.6 million grant from the National Eye Institute of the National Institutes of Health (NIH) to develop a digital camera that would cost about $2,000 and to determine whether it can provide the quality images needed to do the same analysis. If so, many more patients with diabetes could receive the timely check-ups they need.
"We've developed a prototype for the camera," Abramoff said. "It's complex technically, but uses parts that are easily available, such as components normally found in DVD players and bar-code scanning devices."
In addition, Abramoff has teamed with Cindy Wolff, M.D., a family physician in Akron, Iowa, to study how well patients accept having an eye exam that takes place in a non-ophthalmology setting and also depends on distant expertise. The Wellmark Foundation has provided a one-year, $30,000 grant to support this investigation.
Abramoff also is involved in research to design computer programs that will analyze the digital images of patients' eyes and provide a diagnosis. The software would save time for retinal specialists, freeing them up to do advanced care, such as surgery, necessary for those patients with diabetes who are found to have problems. In 2002, Abramoff received a nearly $255,000 grant from the Netherlands Organization for Health-Related Research to pursue this study with collaborators Meindert Niemeier and Bram van Ginneken of the University of Utrecht.
"Our hope is that these studies will collectively allow us to bring an improved quality of care to the citizens of Iowa, as well as other people with diabetes," Abramoff said.
Study collaborators on the NIH grant include UI researchers Thomas Weingeist, M.D., Ph.D., professor and head of ophthalmology; Randy Kardon, M.D., Ph.D., professor of ophthalmology and a staff physician and researcher with the VA Iowa City Health Care System; Thomas Oetting, M.D., clinical associate professor of ophthalmology and researcher and head of ophthalmology at the VA Iowa City; Milan Sonka, Ph.D., professor of electrical and computer engineering; and Barcey Levy, M.D., associate professor of family medicine. Other participating researchers are from the VA Minneapolis Health Care System and the Wisconsin Grading Center at the University of Wisconsin.
For more information about the digital cameras used to screen for diabetic retinopathy, visit webscreen.ophth.uiowa.edu.
University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.
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